In Parkinson’s disease, the optimal attentional focus strategy for dual-task walking may vary with freezing of gait (FOG), due to different severities of impaired automaticity. The study aimed to investigate (i) the immediate effect of attentional focus on dual-task walking in participants with and without FOG, and (ii) the training effect of attentional focus on walking, FOG, and falls. In experiment 1, FOG and non-FOG groups (16 participants each) performed a dual-task of holding two interlocking rings apart while walking, either without attention instruction or with instructions to focus attention internally or externally. Gait parameters and ring-touching times were measured. In experiment 2, 30 participants with FOG were randomized to 6 weeks of dual-task training with internal-focus or external-focus instruction. Before and after training, we recorded timed up-and-go (TUG) and TUG dual-task (TUGdt) in on-medication and off-medication states, and the numbers of FOG episodes and falls. The non-FOG group showed less step length variability and shorter ring-touching times with external-focus. The FOG group showed less step length variability, less cadence, increased gait velocity, and longer step lengths with internal-focus compared to external-focus and no-focus instructions. Both internal-focus and external-focus training reduced FOG and falls after intervention, but only internal-focus training reduced TUG and TUGdt in both on-medication and off-medication states. Our findings suggest external-focus would enhance walking automaticity and the concurrent task accuracy for non-freezers, whereas for freezers, internal-focus could increase gait stability and lead to a more positive effect on improving locomotion control and reducing falling risk.

在帕金森氏症中，由于自律性受损的严重程度不同，双重任务行走的最佳注意力集中策略可能会因步态冻结 (FOG) 而异。该研究旨在调查 ( i ) 注意力集中对有和没有 FOG 的参与者的双重任务行走的直接影响，以及 ( ii)注意力集中对行走、FOG、跌倒的训练效果。在实验 1 中，FOG 和非 FOG 组（每组 16 名参与者）执行了一项双重任务，即在行走时将两个互锁环分开，没有注意力指导或有将注意力集中在内部或外部的说明。测量了步态参数和环接触时间。在实验 2 中，30 名患有 FOG 的参与者被随机分配到 6 周的双任务训练中，包括内部关注或外部关注指导。在训练前后，我们记录了服药和停药状态下的定时起步 (TUG) 和 TUG 双任务 (TUGdt)，以及 FOG 发作和跌倒的次数。非 FOG 组显示出较小的步长可变性和较短的外部焦点环接触时间。FOG 组表现出较少的步长可变性、较少的节奏、与外部聚焦和非聚焦指令相比，内部聚焦的步态速度更快，步长更长。内聚焦和外聚焦训练都减少了干预后的 FOG 和跌倒，但只有内聚焦训练减少了服药和停药状态下的 TUG 和 TUGdt。我们的研究结果表明，外部关注会提高非冷冻者的行走自动化和并发任务的准确性，而对于冷冻者，内部关注可能会增加步态稳定性，并对改善运动控制和降低跌倒风险产生更积极的影响。但只有内部焦点训练减少了服药和停药状态下的 TUG 和 TUGdt。我们的研究结果表明，外部关注会提高非冷冻者的行走自动化和并发任务的准确性，而对于冷冻者，内部关注可能会增加步态稳定性，并对改善运动控制和降低跌倒风险产生更积极的影响。但只有内部焦点训练减少了服药和停药状态下的 TUG 和 TUGdt。我们的研究结果表明，外部关注会提高非冷冻者的行走自动化和并发任务的准确性，而对于冷冻者，内部关注可能会增加步态稳定性，并对改善运动控制和降低跌倒风险产生更积极的影响。